(B) Observational studies of bone mineral density and fractures—children | ||||||
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Study | Ascertainment of BMD | Ascertainment of exposure | Definition of ICS use | Adjustments | ICS exposure | BMD (g/cm) |
Agertoft and Pedersen21 | DEXA scan at one visit, performed by same investigator blinded to treatment group | Compliance checked: Good Duration: Mean 1603 days |
Asthmatic children with ICS use continuously for ≥3 years Type of inhaler: MDI; Turbuhaler Type of steroid: BUD |
Log of accumulated dose of BUD; gender; age | Mean ICS BUD dose 504 μg (daily) | Mean BMD: BUD group: 0.92 Control group: 0.92 |
Allen et al22 | DEXA scan at baseline and again at 9–20 months later. Value for 12-month time point calculated with all outcomes | Compliance checked: Adequate Duration of follow-up: 9–20 months |
Type of inhaler: Spacer, Turbohaler Type of steroid: BDP, BUD |
Age; height; weight; dose of inhaled corticosteroid | Mean ICS dose 0.67±0.48 mg/m2/day | Change in mean vertebral BMD (SD) over 12 months: ICS group (n=47): 0.03±0.03 Control group (n=9): 0.06±0.04 p:<0.025 |
Bahceciler et al23 | Anteroposterior (AP) spine (L2–4) by DEXA scan | Compliance: not reported Follow-up: 13.0±9.8 months |
Use of BUD as MDI ≥6 months | None | ICS Mean daily dose (SD): 419±154 μg | Mean lumbar spine BMD: ICS group: 0.593 (SD 0.122) |
Control | Mean lumbar spine BMD: 0.579 (SD 0.156) | |||||
Harris et al25 | Lumbar spine by DEXA | Compliance checked: not reported Duration of follow-up: 3.5±2.4 years |
Stratified by treatment in past 6 months Type of inhaler: Spacer device Type of steroid: BDP,BUD, FP |
Weight | 0 μg/day | Mean lumbar spine BMD (SD) 0.68 (0.07) |
400–800 μg/day | Mean lumbar spine BMD (SD) 0.70 (0.08) |
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>800 μg/day | Mean lumbar spine BMD (SD) 0.67 (0.08) |